Undiagnosed Metachromatic Leukodystrophy Presenting as Severe Gastrointestinal Bleeding and Cholestasis from Hemobilia.

• Type of Material: Article
• Authors: James P Stevens, Emory University; Janani Dakshinamoorthy, Emory University; Anne Gill, Emory University; Paul Parker, Emory University; Duke Geem, Emory University; John-Paul Berauer, Emory University; Bess Schoen, Emory University; Nitika Gupta, Emory University; Rene Romero, Emory University
• Language: English
• Date: 2021-11
• Publisher: Wolters Kluwer
• Publication Version: Final Published Version
• Copyright Statement: © 2021 The Author(s). Published by Wolters Kluwer on behalf of European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1097/PG9.0000000000000122
• Title of Journal or Parent Work: JPGN Rep
• Volume: 2
• Issue: 4
• Start Page: e122
• End Page: e122
• Keywords: hemobilia; gallbladder polyposis; upper gastrointestinal bleeding; metachromatic leukodystrophy
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Radiology

Abstract

Metachromatic leukodystrophy (MLD) is a neurodegenerative disorder caused by the accumulation of lipids called sulfatides throughout the nervous system. Sulfatides can also collect in other organs throughout the body including the gallbladder where they form polyps. Gallbladder polyps rarely have been found to bleed in patients with known MLD, presumably due to polyp shearing. Here we present a case of a child with autism presenting with severe gastrointestinal bleeding and direct hyperbilirubinemia, requiring significant resuscitation and biliary drain placement to tamponade ongoing bleeding. Subsequent neurologic and genetic investigation led to the diagnosis of MLD, with laparoscopic cholecystectomy revealing extensive, elongated gallbladder polyps. Clinicians who care for patients with MLD, including gastroenterologists who manage their progressive oropharyngeal dysphagia, should be aware of the risk for this life-threatening complication. Moreover, pediatric gastroenterologists and hepatologists should maintain a high index of suspicion for MLD in new patients presenting with developmental regression and gastrointestinal bleeding.